{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T02:00:39Z","timestamp":1783821639874,"version":"3.55.0"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>While endonasal transsphenoidal surgery (ETS) is the standard treatment for nonfunctioning pituitary adenomas (NFPAs), the postoperative recovery rates of secondary adrenal insufficiency and their predictive factors remain poorly understood. The authors investigated the relationship between the tumor resection rate and adrenal function recovery in patients with NFPAs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective study included 450 patients with NFPAs who underwent ETS between January 2013 and November 2023. The rates of preoperative hypopituitarism and postoperative recovery rates of secondary adrenal insufficiency and their associated factors were analyzed. Recovery was defined as normalization of serum cortisol levels without replacement therapy for at least 24 hours, accompanied by symptom resolution. The tumor resection rate was calculated as the percentage of the tumor volume resected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The median follow-up period for the entire cohort was 52 months (range 1\u2013131 months). A total of 246 (55%) patients had dysfunction in one or more pituitary axes. Fifty-three (47%) of 114 patients with preoperative adrenal insufficiency showed postoperative adrenal insufficiency recovery. The cumulative adrenal insufficiency recovery rates were 12% at 1 month, 19% at 3 months, 32% at 6 months, and 41% at 12 months. Among the 114 patients with preoperative adrenal insufficiency, the factors associated with postoperative adrenal insufficiency recovery were investigated. Patients with smaller tumor sizes of &lt; 20 mm (log-rank test, p = 0.001) and those with tumor resection rates of more than 85% (log-rank test, p = 0.032) demonstrated better postoperative adrenal insufficiency improvement. Bivariate Cox proportional hazards analysis demonstrated that smaller tumor sizes (continuous, HR 0.97, 95% CI 0.93\u20130.98; p = 0.043) and higher tumor resection rates (HR 1.03, 95% CI 1.01\u20131.07; p = 0.001) were significantly associated with better postoperative adrenal insufficiency recovery. Multivariable analysis confirmed that only higher tumor resection rates were significantly associated with better postoperative adrenal insufficiency recovery (HR 1.03, 95% CI 1.01\u20131.06; p = 0.019).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Nearly half of the patients with preoperative adrenal insufficiency achieved recovery after ETS for NFPAs. The enhanced extent of tumor removal was an independent factor associated with better postoperative recovery, indicating that optimizing safe maximal resection procedures may be crucial in enhancing adrenal function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.6.jns25607","type":"journal-article","created":{"date-parts":[[2025,11,8]],"date-time":"2025-11-08T01:40:08Z","timestamp":1762566008000},"page":"624-632","source":"Crossref","is-referenced-by-count":1,"title":["Impact of the extent of tumor resection on adrenal function recovery after transsphenoidal surgery for nonfunctioning pituitary adenomas"],"prefix":"10.3171","volume":"144","author":[{"given":"Yuki","family":"Shinya","sequence":"first","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"},{"name":"Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justine S.","family":"Herndon","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandhya R.","family":"Palit","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukwoo","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"},{"name":"Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Erickson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Bancos","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Donegan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Pinheiro Neto","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredric B.","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John L. D.","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie J.","family":"Van Gompel","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"},{"name":"Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"16","key":"b1","series-title":"JAMA","first-page":"1386","article-title":"Diagnosis and management of pituitary adenomas: a review","volume":"329","author":"Tritos NA","year":"2023","unstructured":"Tritos NA, Miller KK. Diagnosis and management of pituitary adenomas: a review. JAMA. 2023;329(16):1386\u20131398."},{"issue":"5","key":"b2","series-title":"Nat Rev Endocrinol","first-page":"278","article-title":"Consensus guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence: part 1, general recommendations","volume":"20","author":"Korbonits M","year":"2024","unstructured":"Korbonits M, Blair JC, Boguslawska A,  Consensus guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence: part 1, general recommendations. Nat Rev Endocrinol. 2024;20(5):278\u2013289."},{"issue":"2","key":"b3","series-title":"Endocrine","first-page":"340","article-title":"The impact of transsphenoidal surgery on pituitary function in patients with non-functioning macroadenomas","volume":"81","author":"Mavromati M","year":"2023","unstructured":"Mavromati M, Mavrakanas T, Jornayvaz FR,  The impact of transsphenoidal surgery on pituitary function in patients with non-functioning macroadenomas. Endocrine. 2023;81(2):340\u2013348."},{"issue":"4","key":"b4","series-title":"Neurosurgery","first-page":"E527","article-title":"Congress of Neurological Surgeons systematic review and evidence-based guideline for pretreatment endocrine evaluation of patients with nonfunctioning pituitary adenomas","volume":"79","author":"Fleseriu M","year":"2016","unstructured":"Fleseriu M, Bodach ME, Tumialan LM,  Congress of Neurological Surgeons systematic review and evidence-based guideline for pretreatment endocrine evaluation of patients with nonfunctioning pituitary adenomas. Neurosurgery. 2016;79(4):E527\u2013E529."},{"issue":"1","key":"b5","series-title":"Endocrine","first-page":"166","article-title":"Outcome of pituitary hormone deficits after surgical treatment of nonfunctioning pituitary macroadenomas","volume":"73","author":"Alexopoulou O","year":"2021","unstructured":"Alexopoulou O, Everard V, Etoa M,  Outcome of pituitary hormone deficits after surgical treatment of nonfunctioning pituitary macroadenomas. Endocrine. 2021;73(1):166\u2013176."},{"issue":"11","key":"b6","series-title":"Endocr J","first-page":"965","article-title":"Relationship of each anterior pituitary hormone deficiency to the size of non-functioning pituitary adenoma in the hospitalized patients","volume":"63","author":"Mukai K","year":"2016","unstructured":"Mukai K, Kitamura T, Tamada D, Murata M, Otsuki M, Shimomura I. Relationship of each anterior pituitary hormone deficiency to the size of non-functioning pituitary adenoma in the hospitalized patients. Endocr J. 2016;63(11):965\u2013976."},{"key":"b7","series-title":"World Neurosurg","first-page":"e1183","article-title":"Clinical characteristics and postoperative recovery of hypopituitarism in patients with nonfunctional pituitary adenoma","volume":"126","author":"Zhang R","year":"2019","unstructured":"Zhang R, Wang Z, Gao L,  Clinical characteristics and postoperative recovery of hypopituitarism in patients with nonfunctional pituitary adenoma. World Neurosurg. 2019;126:e1183\u2013e1189."},{"issue":"4","key":"b8","series-title":"Pituitary","first-page":"389","article-title":"Axis-specific analysis and predictors of endocrine recovery and deficits for non-functioning pituitary adenomas undergoing endoscopic transsphenoidal surgery","volume":"23","author":"Hwang JY","year":"2020","unstructured":"Hwang JY, Aum DJ, Chicoine MR,  Axis-specific analysis and predictors of endocrine recovery and deficits for non-functioning pituitary adenomas undergoing endoscopic transsphenoidal surgery. Pituitary. 2020;23(4):389\u2013399."},{"issue":"4","key":"b9","series-title":"Neurosurgery","first-page":"E533","article-title":"Congress of Neurological Surgeons systematic review and evidence-based guideline on primary management of patients with nonfunctioning pituitary adenomas","volume":"79","author":"Lucas JW","year":"2016","unstructured":"Lucas JW, Bodach ME, Tumialan LM,  Congress of Neurological Surgeons systematic review and evidence-based guideline on primary management of patients with nonfunctioning pituitary adenomas. Neurosurgery. 2016;79(4):E533\u2013E535."},{"issue":"10","key":"b10","series-title":"J Clin Endocrinol Metab","first-page":"3696","article-title":"Recovery of hypopituitarism after neurosurgical treatment of pituitary adenomas","volume":"84","author":"Webb SM","year":"1999","unstructured":"Webb SM, Rigla M, W\u00e4gner A, Oliver B, Bartumeus F. Recovery of hypopituitarism after neurosurgical treatment of pituitary adenomas. J Clin Endocrinol Metab. 1999;84(10):3696\u20133700."},{"issue":"11","key":"b11","series-title":"J Clin Endocrinol Metab","first-page":"5316","article-title":"Recovery of the hypothalamo-pituitary-adrenal axis after transsphenoidal adenomectomy for non-ACTH-secreting macroadenomas","volume":"104","author":"Pofi R","year":"2019","unstructured":"Pofi R, Gunatilake S, Macgregor V,  Recovery of the hypothalamo-pituitary-adrenal axis after transsphenoidal adenomectomy for non-ACTH-secreting macroadenomas. J Clin Endocrinol Metab. 2019;104(11):5316\u20135324."},{"issue":"3","key":"b12","series-title":"J Neurosurg","first-page":"589","article-title":"Improved versus worsened endocrine function after transsphenoidal surgery for nonfunctional pituitary adenomas: rate, time course, and radiological analysis","volume":"124","author":"Jahangiri A","year":"2016","unstructured":"Jahangiri A, Wagner JR, Han SW,  Improved versus worsened endocrine function after transsphenoidal surgery for nonfunctional pituitary adenomas: rate, time course, and radiological analysis. J Neurosurg. 2016;124(3):589\u2013595."},{"issue":"2","key":"b13","series-title":"Endocrine","first-page":"407","article-title":"Non-functioning pituitary macroadenomas: factors affecting postoperative recurrence, and pre- and post-surgical endocrine and visual function","volume":"73","author":"Subramanian V","year":"2021","unstructured":"Subramanian V, Lee RSM, Howell S,  Non-functioning pituitary macroadenomas: factors affecting postoperative recurrence, and pre- and post-surgical endocrine and visual function. Endocrine. 2021;73(2):407\u2013415."},{"issue":"4","key":"b14","series-title":"Neurosurgery","first-page":"709","article-title":"Pituitary hormonal loss and recovery after transsphenoidal adenoma removal","volume":"63","author":"Fatemi N","year":"2008","unstructured":"Fatemi N, Dusick JR, Mattozo C,  Pituitary hormonal loss and recovery after transsphenoidal adenoma removal. Neurosurgery. 2008;63(4):709\u2013719."},{"issue":"3","key":"b15","series-title":"J Neurosurg","first-page":"781","article-title":"Correlation of older age with better progression-free survival despite less aggressive resection in nonfunctioning pituitary adenomas","volume":"141","author":"Shinya Y","year":"2024","unstructured":"Shinya Y, Atkinson JLD, Erickson D,  Correlation of older age with better progression-free survival despite less aggressive resection in nonfunctioning pituitary adenomas. J Neurosurg. 2024;141(3):781\u2013789."},{"key":"b16","series-title":"Front Oncol","first-page":"1255768","article-title":"Surgical management of giant pituitary adenomas: institutional experience and clinical outcomes of 94 patients","volume":"13","author":"Ke D","year":"2023","unstructured":"Ke D, Xu L, Wu D,  Surgical management of giant pituitary adenomas: institutional experience and clinical outcomes of 94 patients. Front Oncol. 2023;13:1255768."},{"issue":"2","key":"b17","series-title":"Endocr Pract","first-page":"83","article-title":"The impact of COVID-19 viral infection on the hypothalamic-pituitary-adrenal axis","volume":"27","author":"Alzahrani AS","year":"2021","unstructured":"Alzahrani AS, Mukhtar N, Aljomaiah A,  The impact of COVID-19 viral infection on the hypothalamic-pituitary-adrenal axis. Endocr Pract. 2021;27(2):83\u201389."},{"issue":"4","key":"b18","series-title":"J Neurosurg","first-page":"1043","article-title":"Results of a prospective multicenter controlled study comparing surgical outcomes of microscopic versus fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas: the Transsphenoidal Extent of Resection (TRANSSPHER) Study","volume":"132","author":"Little AS","year":"2020","unstructured":"Little AS, Kelly DF, White WL,  Results of a prospective multicenter controlled study comparing surgical outcomes of microscopic versus fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas: the Transsphenoidal Extent of Resection (TRANSSPHER) Study. J Neurosurg. 2020;132(4):1043\u20131053."},{"issue":"4","key":"b19","series-title":"Neurosurgery","first-page":"610","article-title":"Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings","volume":"33","author":"Knosp E","year":"1993","unstructured":"Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery. 1993;33(4):610\u2013618."},{"issue":"4","key":"b20","series-title":"J Neurosurg","first-page":"803","article-title":"Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification","volume":"122","author":"Micko ASG","year":"2015","unstructured":"Micko ASG, W\u00f6hrer A, Wolfsberger S, Knosp E. Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification. J Neurosurg. 2015;122(4):803\u2013811."},{"issue":"3","key":"b21","series-title":"J Neurosurg","first-page":"889","article-title":"Primary versus revision transsphenoidal resection for nonfunctioning pituitary macroadenomas: matched cohort study","volume":"126","author":"Przybylowski CJ","year":"2017","unstructured":"Przybylowski CJ, Dallapiazza RF, Williams BJ,  Primary versus revision transsphenoidal resection for nonfunctioning pituitary macroadenomas: matched cohort study. J Neurosurg. 2017;126(3):889\u2013896."},{"issue":"4","key":"b22","series-title":"Neurosurg Focus","first-page":"E19","article-title":"Clinical characteristics and outcomes in elderly patients undergoing transsphenoidal surgery for nonfunctioning pituitary adenoma","volume":"49","author":"Pereira MP","year":"2020","unstructured":"Pereira MP, Oh T, Joshi RS,  Clinical characteristics and outcomes in elderly patients undergoing transsphenoidal surgery for nonfunctioning pituitary adenoma. Neurosurg Focus. 2020;49(4):E19."},{"issue":"2","key":"b23","series-title":"Pituitary","first-page":"145","article-title":"Management of non-functioning pituitary adenomas: surgery","volume":"21","author":"Penn DL","year":"2018","unstructured":"Penn DL, Burke WT, Laws ER. Management of non-functioning pituitary adenomas: surgery. Pituitary. 2018;21(2):145\u2013153."},{"issue":"16","key":"b1","series-title":"JAMA","first-page":"1386","article-title":"Diagnosis and management of pituitary adenomas: a review","volume":"329","author":"Tritos NA","year":"2023","unstructured":"Tritos NA, Miller KK. Diagnosis and management of pituitary adenomas: a review. JAMA. 2023;329(16):1386\u20131398."},{"issue":"5","key":"b2","series-title":"Nat Rev Endocrinol","first-page":"278","article-title":"Consensus guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence: part 1, general recommendations","volume":"20","author":"Korbonits M","year":"2024","unstructured":"Korbonits M, Blair JC, Boguslawska A,  Consensus guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence: part 1, general recommendations. Nat Rev Endocrinol. 2024;20(5):278\u2013289."},{"issue":"2","key":"b3","series-title":"Endocrine","first-page":"340","article-title":"The impact of transsphenoidal surgery on pituitary function in patients with non-functioning macroadenomas","volume":"81","author":"Mavromati M","year":"2023","unstructured":"Mavromati M, Mavrakanas T, Jornayvaz FR,  The impact of transsphenoidal surgery on pituitary function in patients with non-functioning macroadenomas. Endocrine. 2023;81(2):340\u2013348."},{"issue":"4","key":"b4","series-title":"Neurosurgery","first-page":"E527","article-title":"Congress of Neurological Surgeons systematic review and evidence-based guideline for pretreatment endocrine evaluation of patients with nonfunctioning pituitary adenomas","volume":"79","author":"Fleseriu M","year":"2016","unstructured":"Fleseriu M, Bodach ME, Tumialan LM,  Congress of Neurological Surgeons systematic review and evidence-based guideline for pretreatment endocrine evaluation of patients with nonfunctioning pituitary adenomas. Neurosurgery. 2016;79(4):E527\u2013E529."},{"issue":"1","key":"b5","series-title":"Endocrine","first-page":"166","article-title":"Outcome of pituitary hormone deficits after surgical treatment of nonfunctioning pituitary macroadenomas","volume":"73","author":"Alexopoulou O","year":"2021","unstructured":"Alexopoulou O, Everard V, Etoa M,  Outcome of pituitary hormone deficits after surgical treatment of nonfunctioning pituitary macroadenomas. Endocrine. 2021;73(1):166\u2013176."},{"issue":"11","key":"b6","series-title":"Endocr J","first-page":"965","article-title":"Relationship of each anterior pituitary hormone deficiency to the size of non-functioning pituitary adenoma in the hospitalized patients","volume":"63","author":"Mukai K","year":"2016","unstructured":"Mukai K, Kitamura T, Tamada D, Murata M, Otsuki M, Shimomura I. Relationship of each anterior pituitary hormone deficiency to the size of non-functioning pituitary adenoma in the hospitalized patients. Endocr J. 2016;63(11):965\u2013976."},{"key":"b7","series-title":"World Neurosurg","first-page":"e1183","article-title":"Clinical characteristics and postoperative recovery of hypopituitarism in patients with nonfunctional pituitary adenoma","volume":"126","author":"Zhang R","year":"2019","unstructured":"Zhang R, Wang Z, Gao L,  Clinical characteristics and postoperative recovery of hypopituitarism in patients with nonfunctional pituitary adenoma. World Neurosurg. 2019;126:e1183\u2013e1189."},{"issue":"4","key":"b8","series-title":"Pituitary","first-page":"389","article-title":"Axis-specific analysis and predictors of endocrine recovery and deficits for non-functioning pituitary adenomas undergoing endoscopic transsphenoidal surgery","volume":"23","author":"Hwang JY","year":"2020","unstructured":"Hwang JY, Aum DJ, Chicoine MR,  Axis-specific analysis and predictors of endocrine recovery and deficits for non-functioning pituitary adenomas undergoing endoscopic transsphenoidal surgery. Pituitary. 2020;23(4):389\u2013399."},{"issue":"4","key":"b9","series-title":"Neurosurgery","first-page":"E533","article-title":"Congress of Neurological Surgeons systematic review and evidence-based guideline on primary management of patients with nonfunctioning pituitary adenomas","volume":"79","author":"Lucas JW","year":"2016","unstructured":"Lucas JW, Bodach ME, Tumialan LM,  Congress of Neurological Surgeons systematic review and evidence-based guideline on primary management of patients with nonfunctioning pituitary adenomas. Neurosurgery. 2016;79(4):E533\u2013E535."},{"issue":"10","key":"b10","series-title":"J Clin Endocrinol Metab","first-page":"3696","article-title":"Recovery of hypopituitarism after neurosurgical treatment of pituitary adenomas","volume":"84","author":"Webb SM","year":"1999","unstructured":"Webb SM, Rigla M, W\u00e4gner A, Oliver B, Bartumeus F. Recovery of hypopituitarism after neurosurgical treatment of pituitary adenomas. J Clin Endocrinol Metab. 1999;84(10):3696\u20133700."},{"issue":"11","key":"b11","series-title":"J Clin Endocrinol Metab","first-page":"5316","article-title":"Recovery of the hypothalamo-pituitary-adrenal axis after transsphenoidal adenomectomy for non-ACTH-secreting macroadenomas","volume":"104","author":"Pofi R","year":"2019","unstructured":"Pofi R, Gunatilake S, Macgregor V,  Recovery of the hypothalamo-pituitary-adrenal axis after transsphenoidal adenomectomy for non-ACTH-secreting macroadenomas. J Clin Endocrinol Metab. 2019;104(11):5316\u20135324."},{"issue":"3","key":"b12","series-title":"J Neurosurg","first-page":"589","article-title":"Improved versus worsened endocrine function after transsphenoidal surgery for nonfunctional pituitary adenomas: rate, time course, and radiological analysis","volume":"124","author":"Jahangiri A","year":"2016","unstructured":"Jahangiri A, Wagner JR, Han SW,  Improved versus worsened endocrine function after transsphenoidal surgery for nonfunctional pituitary adenomas: rate, time course, and radiological analysis. J Neurosurg. 2016;124(3):589\u2013595."},{"issue":"2","key":"b13","series-title":"Endocrine","first-page":"407","article-title":"Non-functioning pituitary macroadenomas: factors affecting postoperative recurrence, and pre- and post-surgical endocrine and visual function","volume":"73","author":"Subramanian V","year":"2021","unstructured":"Subramanian V, Lee RSM, Howell S,  Non-functioning pituitary macroadenomas: factors affecting postoperative recurrence, and pre- and post-surgical endocrine and visual function. Endocrine. 2021;73(2):407\u2013415."},{"issue":"4","key":"b14","series-title":"Neurosurgery","first-page":"709","article-title":"Pituitary hormonal loss and recovery after transsphenoidal adenoma removal","volume":"63","author":"Fatemi N","year":"2008","unstructured":"Fatemi N, Dusick JR, Mattozo C,  Pituitary hormonal loss and recovery after transsphenoidal adenoma removal. Neurosurgery. 2008;63(4):709\u2013719."},{"issue":"3","key":"b15","series-title":"J Neurosurg","first-page":"781","article-title":"Correlation of older age with better progression-free survival despite less aggressive resection in nonfunctioning pituitary adenomas","volume":"141","author":"Shinya Y","year":"2024","unstructured":"Shinya Y, Atkinson JLD, Erickson D,  Correlation of older age with better progression-free survival despite less aggressive resection in nonfunctioning pituitary adenomas. J Neurosurg. 2024;141(3):781\u2013789."},{"key":"b16","series-title":"Front Oncol","first-page":"1255768","article-title":"Surgical management of giant pituitary adenomas: institutional experience and clinical outcomes of 94 patients","volume":"13","author":"Ke D","year":"2023","unstructured":"Ke D, Xu L, Wu D,  Surgical management of giant pituitary adenomas: institutional experience and clinical outcomes of 94 patients. Front Oncol. 2023;13:1255768."},{"issue":"2","key":"b17","series-title":"Endocr Pract","first-page":"83","article-title":"The impact of COVID-19 viral infection on the hypothalamic-pituitary-adrenal axis","volume":"27","author":"Alzahrani AS","year":"2021","unstructured":"Alzahrani AS, Mukhtar N, Aljomaiah A,  The impact of COVID-19 viral infection on the hypothalamic-pituitary-adrenal axis. Endocr Pract. 2021;27(2):83\u201389."},{"issue":"4","key":"b18","series-title":"J Neurosurg","first-page":"1043","article-title":"Results of a prospective multicenter controlled study comparing surgical outcomes of microscopic versus fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas: the Transsphenoidal Extent of Resection (TRANSSPHER) Study","volume":"132","author":"Little AS","year":"2020","unstructured":"Little AS, Kelly DF, White WL,  Results of a prospective multicenter controlled study comparing surgical outcomes of microscopic versus fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas: the Transsphenoidal Extent of Resection (TRANSSPHER) Study. J Neurosurg. 2020;132(4):1043\u20131053."},{"issue":"4","key":"b19","series-title":"Neurosurgery","first-page":"610","article-title":"Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings","volume":"33","author":"Knosp E","year":"1993","unstructured":"Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery. 1993;33(4):610\u2013618."},{"issue":"4","key":"b20","series-title":"J Neurosurg","first-page":"803","article-title":"Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification","volume":"122","author":"Micko ASG","year":"2015","unstructured":"Micko ASG, W\u00f6hrer A, Wolfsberger S, Knosp E. Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification. J Neurosurg. 2015;122(4):803\u2013811."},{"issue":"3","key":"b21","series-title":"J Neurosurg","first-page":"889","article-title":"Primary versus revision transsphenoidal resection for nonfunctioning pituitary macroadenomas: matched cohort study","volume":"126","author":"Przybylowski CJ","year":"2017","unstructured":"Przybylowski CJ, Dallapiazza RF, Williams BJ,  Primary versus revision transsphenoidal resection for nonfunctioning pituitary macroadenomas: matched cohort study. J Neurosurg. 2017;126(3):889\u2013896."},{"issue":"4","key":"b22","series-title":"Neurosurg Focus","first-page":"E19","article-title":"Clinical characteristics and outcomes in elderly patients undergoing transsphenoidal surgery for nonfunctioning pituitary adenoma","volume":"49","author":"Pereira MP","year":"2020","unstructured":"Pereira MP, Oh T, Joshi RS,  Clinical characteristics and outcomes in elderly patients undergoing transsphenoidal surgery for nonfunctioning pituitary adenoma. Neurosurg Focus. 2020;49(4):E19."},{"issue":"2","key":"b23","series-title":"Pituitary","first-page":"145","article-title":"Management of non-functioning pituitary adenomas: surgery","volume":"21","author":"Penn DL","year":"2018","unstructured":"Penn DL, Burke WT, Laws ER. Management of non-functioning pituitary adenomas: surgery. 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